Program Registration Form

This is the online registration for our programs. This includes a review and acceptance of the Operation Climb On (OCO) Participant Agreement, Release & Assumption of Risk form. Additionally, you will be required to provide information concerning your health and emergency contact. If further information is necessary, you will be contacted by our administrative team. Please contact us directly with any questions. We look forward to your participation in our programs!

PARTICIPANT AGREEMENT, RELEASE, AND ASSUMPTION OF RISK

In consideration of the services ofOperation Climb On, their agents, owners, directors, officers, volunteers, agents, employees, affiliates, and all other persons or entities acting in any capacity on their behalf (hereinafter collectively referred to as “ OCO"), I hereby agree to release, indemnify, and discharge OCO, on behalf of myself, spouse, children, and parents as follows:

I acknowledge that outdoor adventure-based activities such as rock and ice climbing, snowshoeing, and canyoneering entail known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself and/or property. I understand that such risks cannot be eliminated without jeopardizing the integrity of the activity.

I acknowledge that I have been informed of the inherent risks which include, among other things:

Exposure to outdoor elements including, but not limited to slips and falls from climbing and/or walking on uneven terrain; being struck by rock fall, ice fall or other objects dislodged or thrown from above.

Accidents or illness occurring in remote areas with poor or no access to emergency and/or medical services; improper lifting or carrying.

Fatigue and/or exhaustion due to the physical exertion associated with these activities.

Furthermore, OCO employees seek safety, but are not infallible. They may be unaware of a participant's fitness or abilities. They might misjudge the weather or other environmental conditions. They may give incomplete warnings or instructions, and equipment being used might malfunction.

I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate despite of the risks.

I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless OCO from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of OCO's equipment or facilities, including any such claims which allege negligent acts or omissions of OCO.

Should OCO or anyone acting on their behalf, be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to personally bear the costs of such injury or damage independently. I further certify that I am willing to assume the risk of any medical or physical condition I may have.

In the event that I file a lawsuit against OCO, I agree to do so solely in the state of Utah, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.

I grant permission to OCO to take still and moving images of me and use them for promotional purposes without recourse or compensation to me. If I submit my photographs I hereby release OCO to use them in marketing without recourse or compensation to me.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against OCO on the basis of any claim from which I have released them herein.

I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms.

Electronic Agreement of Terms *

By checking this box, I agree to the terms and conditions set forth in the above Participant Agreement & Assumption of Risk explanation

Program Information

Program Date *

Please select the program date(s) you wish to attend.

July 30

August 13

August 27

Rental Equipment Needed *

Harness

Helmet

Rock Shoes

Belay Device

I have all of the above-listed equipment

Shoe Size

Have you participated in an OCO program previously?

If so, which program(s)?

How did you hear about us?

Participant Information

Name *

Name

First Name

Last Name

Phone *

Phone

(###)

###

####

Email Address *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Branch of Service *

Pertinent Medical History & Emergency Contact Information

Height

Weight

Gender

Date of Birth

Date of Birth

MM

DD

YYYY

Insurance Provider

Insurance Policy Number

Emergency Contact *

Emergency Contact

First Name

Last Name

Emergency Contact Phone *

Emergency Contact Phone

(###)

###

####

Do you currently or have your had a history of:

(check all that apply)

Hypertension

Heart palpitations

Chest pain/pressure

Heart attack/disease

Heart murmur

Smoking

Respiratory problems

Genitourinary concerns

Infectious disease

Dizziness or fainting

Recent illness

Spine pain or injury

Eating disorders

Heat injury

Major surgery

Stroke

Joint or extremity pain/injury

Gastrointestinal concerns

Bleeding or blood disorder

Neurologic problems/seizures

Mental health concerns

Diabetes

Dietary restrictions

Frostbite or cold injury

Altitude injury

Physical disability

Allergies (insects, food, drug)

Any other health concerns?

Are you pregnant?

Currently under the care of a medical professional

Currently using or carrying any medications

If you answered yes to any of the above listed questions, please explain

Describe your current physical fitness and level of activity

To the best of my knowledge, the above information is a complete and accurate representation of my pertinent medical history. I declare that I am in good physical health and believe that I am able without reservation or limiting conditions to physically withstand and cope with the indicated rigors of the program. In the event of an emergency, permission is given for any evacuation, medical intervention, and care that may become necessary for my immediate well-being. By selecting this box, I acknowledge that I agree to the above information electronically and allow this electronic submission. *

I AGREE (Participant Health Statement Acknowledgement)

Participant Age Verification

I certify that I am 18 years of age or older

Electronic Signature

I declare, under penalties of perjury and as an authorized authority, that this filing has been examined by me and is, to the best of my knowledge and belief, true, correct, and complete. By typing my name in the indicated field, I agree to the terms and conditions outlined in the Participant Agreement, Release & Acknowledgement of Risk explanation

Date of Agreement

Date of Agreement

MM

DD

YYYY

Parent's or Guardian's Additional Indemnification

(Must be completed for participants under the age of 18)

Minor's Name

Minor's Name

In consideration of (listed minor) ("Minor") being permitted by MED to participate in its activities and to use its equipment and facilities. I further agree to indemnify and hold harmless MED from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

First Name

Last Name

Parent or Guardian Electronic Signature

Date of Agreement

Date of Agreement

MM

DD

YYYY

Thanks for registering! Please feel free to contact us with any questions. We look forward to having you as part of our programs. If you need climbing equipment for your program, feel free to rent from us. Not only do you get what you need at an equivalent low cost to other rental options, we bring your equipment with us so you don't need to make an extra trip to pick it up.

We work hard to keep our programs free for the veteran community. That wouldn't be possible without the generous donations of supporters and participants. Help us keep our programs free by contributing a modest donation or by inviting others to do so. All of the funds we receive from donations go right back into our program - all of our team members are volunteers - so you can rest easy knowing that your contributions are directly helping to enhance Operation Climb On's high quality programs.